DI-AAA ADA Professional Development Program MENTEE Application Form

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* 1. NAME

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* 2. INSTITUTION

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* 3. TITLE

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* 4. CONFERENCE

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* 5. EMAIL

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* 6. PHONE

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* 7. Degree Completed, Institution, Year

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* 8. How long have you worked full-time in college athletics administration? (To be considered, it must be at least 3 years)

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* 9. How long have you been in your current position?

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* 10. Please describe your current job responsibilities

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* 11. Please list any previous positions you have held.

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* 12. What type of qualities are you looking for in your mentor?

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* 13. What areas are you interested in learning more about from a mentor to become a relevant, successful leader in our profession and industry? Please list three to five examples.

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* 14. I understand that by expressing my interest in the DI-AAA ADA Mentoring Program and completing this form that there is a level of commitment expected of me. I will assure that I dedicate an appropriate amount of time to my mentor throughout the entirety of this program.

DEADLINE TO SUBMIT APPLICATION: FRIDAY, MAY 11

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